Gallstones and Gallbladder Disease - Prognosis

Highlights	Prevention	Managing Common Bile Duct Stones
Introduction	Diagnosis	Resources
Symptoms	Treatment	References
Prognosis	Surgery
Risk Factors	Lithotripsy and Dissolution Therapies

Prognosis

Asymptomatic gallstones seldom lead to problems. Death from even symptomatic gallstones is very rare, accounting for only 0.2% of annual deaths in the United States. Serious complications are rare and, if they occur, usually develop from stones in the bile duct or after surgery.

Gallstones, however, can cause obstruction at any point along the ducts that carry bile and, in such cases, symptoms can develop:

In most cases of obstruction, the stones block the cystic duct, which leads from the gallbladder to the common bile duct. This can cause pain (biliary colic), infection and inflammation (acute cholecystitis), or both.
About 10% of patients with symptomatic gallstones also have stones that pass into and obstruct the common bile duct (called choledocholithiasis).

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Complications of Acute Cholecystitis

The most serious complication of acute cholecystitis is infection, which develops in about 20% of cases. It is extremely dangerous and life threatening if it spreads to other parts of the body (septicemia). Symptoms include fever, rapid heartbeat, fast breathing, and mental confusion. Among the conditions that can lead to septicemia are the following:

Gangrene or Abscesses. If acute cholecystitis is untreated and becomes very severe, inflammation can cause abscesses or destroy enough tissue in the gallbladder (called necrosis) to lead to gangrene. Studies have reported this complication in between 2 - 30% of cases. The highest risk is in men over 50 with a history of heart disease who have high levels of infection.
Perforated Gallbladder. An estimated 10% of people with acute cholecystitis have a perforated gallbladder, which is a life-threatening condition. In general, this occurs in people who wait too long to seek help or who do not respond to treatment. This condition is most common in people with diabetes. The risk for perforation increases with a condition called emphysematous cholecystitis, in which gas forms in the gallbladder. Once the gallbladder has been perforated, people may experience a temporary decrease in pain. This is a dangerous event, however, since peritonitis (wide spread abdominal infection) develops afterward.
Empyema. Pus in the gallbladder (called empyema) occurs in 2 - 3% of patients with acute cholecystitis. Abdominal pain is usually severe and is typically present for more than seven days. The physical exam is not distinctive. The condition can be life threatening, particularly if the infection spreads to other parts of the body.
Fistula. In some cases, the inflamed gallbladder adheres to and perforates nearby organs, such as the small intestine. In such cases a fistula (a channel) between the organs develops. Sometimes, in these cases, gallstones can actually pass into the small intestine, which can be very serious without immediate surgery.